2012-11-15T11:11:40-06:00 2012-06-30 952242818 VICENTI LLOYD & STUTZMAN LLP 2210 E ROUTE 66 SUITE 100 GLENDORA CA 91740 990 2011-07-01 710876594 HOLLENBECK PALMS HOLL 3232636195 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 JOHNNY YOUNG 3232636195 2012-11-13 1 TIMOTHY D EVANS CPA P00050546 6268577300 2011 2016-02-24 21:20:13Z JOHNNY YOUNG 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 21187098 0 X WWW.HOLLENBECKPALMS.COM X 2001 CA HOLLENBECK PALMS IS COMMITTED TO PROVIDING A RESIDENCE FOR THOSE IN THE LATER YEARS OF THEIR LIVES THAT ENCOMPASSES A HEALTHY ENVIRONMENT OF COMFORT, SAFETY, AND ENJOYMENT; THAT ATTENDS TO THEIR PHYSICAL, MENTAL, AND SPIRTUAL NEEDS; AND THAT IS QUICK TO RESPOND TO AND ASSIST IN THOSE NEEDS WHETHER IMMEDIATE OR LONG TERM, AND TO DO SO WITH GREAT COMPASSION, HONESTY, DIGNITY, AND GENUINE LOVE. 6 6 208 0 0 0 553614 80559 14872593 16010627 1084087 1642529 190090 308101 16700384 18041816 0 0 0 0 7497938 7885889 0 0 0 8147393 8243071 15645331 16128960 1055053 1912856 76051591 75356168 43045968 41723708 33005623 33632460 NONE 0 0 10012142 16318728 HOLLENBECK PALMS PROVIDES CARE FOR THE AGING, INCLUDING RESIDENTIAL AND SKILLED NURSING CARE LIVING ARRANGEMENTS FOR THEIR MEMBERS. 10012142 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 32 0 1 208 1 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X JOHNNY YOUNG 3232636195 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 DAVID ADAMS 1.00 X 0 0 0 PHIL SWAN 1.00 X 0 0 0 CAROL A JOHNSTON 1.00 X 0 0 0 CHARLENE LEIBAU 1.00 X 0 0 0 CASEY ADAMS 1.00 X 0 0 0 TRACY HIRREL 1.00 X 0 0 0 WILLIAM HEIDEMAN 40.00 X 183732 0 57369 MORRIS SHOCKLEY 40.00 X 130010 0 40515 JOHNNY YOUNG 40.00 X 93758 0 26757 RAY SHIVELY 40.00 X 151515 0 31705 CAMILLE GOLDSMITH 40.00 X 143257 0 31003 JOHN M SHIVELY 40.00 X 110738 0 25296 PEGGY L HEIDEMAN 40.00 X 107846 0 38566 920856 0 251211 6 0 1 0 SODEXHO SERVICES DEPT 48283 LOS ANGELES CA 90088 FOOD SERVICES 1101915 TEAM REHAB INC 6531 SILENT HARBOR DR HUNTINGTON BEACH CA 92867 THERAPY 647339 DJMB SERVICES 3475 BARHITE STREET PASADENA CA 91107 HOUSEKEEPING 515217 SKILLED NURSING PHARMACY 16666 E JOHNSON DRIVE CITY OF INDUSTRY CA 91745 PHARMACY 476144 CREATIVE LANDSCAPE & MAINT 14877 SHETLAND LN FONTANA CA 92336 LANDSCAPING 149479 6 80559 80559 SNF & RESIDENTIAL CARE 623990 11227465 11227465 MEDICARE/MEDICAID PAYM 623990 4783162 4783162 16010627 949660 949660 3838151 3145282 692869 692869 692869 ROYALTIES 900099 175394 175394 BEAUTY/BARBER SHOP 900099 61559 61559 GUEST MEAL/ICE CREAM 900099 27683 27683 43465 43465 308101 18041816 16318728 0 1642529 X 532141 532141 5361424 4704542 656882 1992324 1726379 265945 59622 59622 108237 108237 185671 72179 113492 111346 111346 814825 673370 141455 592254 592254 3278 3278 12692 7750 4942 274943 274943 1163498 1163498 242603 242603 OTHER MEDICAL & MEDICAR 1021610 1021610 PURCHASED SERVICES 801652 801652 FOOD EXPENSES 682163 682163 SERVICES 391264 132581 258683 1777413 189916 1587497 16128960 10012142 6116818 0 4279607 4109009 1194086 556732 442884 0 1893618 1791704 157557 170415 187625 215653 45261713 17152587 28771991 28109126 35189625 37095275 3934598 3308254 76051591 75356168 3004085 3794988 24055000 23540000 15986883 14388720 43045968 41723708 X 31444403 32034985 787897 824152 773323 773323 33005623 33632460 76051591 75356168 X 1912856 -1286019 X X 0 1 1 X 0 X 464103 389590 192962 553614 80559 1680828 11504841 11279803 13224245 14872593 16010627 66892109 11968944 11669393 13417207 15426207 16091186 68572937 0 0 0 68572937 1985563 1006691 911599 941580 949652 5795085 1985563 1006691 911599 941580 949652 5795085 180726 198408 149207 190090 308101 1026532 14135233 12874492 14478013 16557877 17348939 75394554 0.90950 0.89950 0.07690 0.08870 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 28092 28092 39756637 13593449 26163188 263938 193026 70912 5213046 3366112 1846934 28109126 DEFERRED REVENUE FROM ACCOMODATION FEES 4000277 ASSIGNED ASSETS 10388443 14388720 18041816 16128960 1912856 -1286019 -1286019 626837 16755797 -1286019 -1286019 18041816 0 18041816 16128960 0 16128960 0 16128960 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE PALMS HAS EVALUATED ITS TAX POSITIONS AND THE CERTAINTY AS TO WHETHER THOSE POSITIONS WILL BE SUSTAINED IN THE EVENT OF AN AUDIT BY TAXING AUTHORITIES AT THE FEDERAL AND STATE LEVELS. THE PRIMARY TAX POSITIONS EVALUATED ARE RELATED TO THE PALMS CONTINUED QUALIFICATION AS A TAX-EXEMPT ORGANIZATION AND WHETHER THERE IS UNRELATED BUSINESS INCOME ACTIVITIES CONDUCTED THAT WOULD BE TAXABLE. MANAGEMENT HAS DETERMINED THAT ALL INCOME TAX POSITIONS ARE MORE LIKELY THAN NOT (>50%) OF BEING SUSTAINED UPON POTENTIAL AUDIT OR EXAMINATION; THEREFORE, NO DISCLOSURES OF UNCERTAIN INCOME TAX POSITIONS ARE REQUIRED. THE PALMS FILES INFORMATIONAL RETURNS IN THE U.S. FEDERAL JURISDICTION AND THE STATE OF CALIFORNIA. THE STATUTE OF LIMITATIONS FOR FEDERAL AND CALIFORNIA STATE PURPOSES IS GENERALLY THREE AND FOUR YEARS, RESPECTIVELY. PART XI, LINE 8 - OTHER ADJUSTMENTS: UNREALIZED LOSS ON INVESTMENTS -434,858. CHANGE IN PREMIUM PENSION -851,161. TOTAL TO SCHEDULE D, PART XI, LINE 8: -1,286,019. PART XII, LINE 2D - OTHER ADJUSTMENTS: UNREALIZED LOSS ON INVESTMENTS -1,286,019. X X 0 0 0 0 0 0 0 0 0 WILLIAM HEIDEMAN 183732 0 0 0 0 0 0 0 57369 0 241101 0 0 0 MORRIS SHOCKLEY 130010 0 0 0 0 0 0 0 40515 0 170525 0 0 0 RAY SHIVELY 151515 0 0 0 0 0 0 0 31705 0 183220 0 0 0 CAMILLE GOLDSMITH 143257 0 0 0 0 0 0 0 31003 0 174260 0 0 0 CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 13079GAH6 2007-02-01 5525000 THE BONDS PROCEEDS WERE USED BY HOLLENBECK PALMS TO DEMOLISH CERTAIN 0 0 0 CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 10379GAJ2 2007-02-01 15035000 EXISTING BUILDINGS, CONTRUCT A NEW THREE-STORY BUILDING CONSISTING OF 0 0 0 CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 13079GAK9 2007-02-01 2700000 RESIDENTIAL UNITS, UNDERGROUND PARKING, AND RELATED FACILITIES. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 NO REVIEW WAS OR WILL BE CONDUCTED FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE SIGNED BY TRUSTEES ANNUALLY AND REVIEWED BY MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 15 BOARD OF TRUSTEES DETERMINES COMPENSATION FOR ALL ORGANIZATIONS AND KEY EMPLOYEES, BASED ON COMPARABLE SALARIES IN THE LOCAL AREA. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: UNREALIZED LOSS ON INVESTMENTS -434,858. CHANGE IN PREMIUM PENSION -851,161. TOTAL TO FORM 990, PART XI, LINE 5: -1,286,019.